| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
5,223 |
4,800 |
$328K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,091 |
1,922 |
$169K |
| 90461 |
|
1,671 |
1,590 |
$68K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
2,512 |
2,374 |
$52K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
155 |
155 |
$16K |
| D1120 |
Prophylaxis - child |
264 |
256 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
108 |
108 |
$13K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
251 |
241 |
$12K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
488 |
478 |
$12K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
138 |
137 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
236 |
223 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
103 |
$8K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
325 |
317 |
$6K |
| 99383 |
|
44 |
44 |
$6K |
| 86580 |
|
353 |
352 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
51 |
49 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
20 |
20 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
43 |
43 |
$3K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
183 |
157 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$2K |
| 99201 |
|
28 |
28 |
$1K |
| 90677 |
|
122 |
121 |
$1K |
| 99401 |
|
29 |
27 |
$1K |
| D1203 |
|
53 |
53 |
$987.00 |
| 80061 |
Lipid panel |
77 |
77 |
$910.52 |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
62 |
62 |
$910.25 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$676.00 |
| 82728 |
|
49 |
49 |
$667.87 |
| 92250 |
|
13 |
13 |
$438.02 |
| D0274 |
Bitewings - four radiographic images |
13 |
12 |
$432.00 |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
51 |
50 |
$396.27 |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$360.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
37 |
37 |
$339.85 |
| 80048 |
Basic metabolic panel (calcium, ionized) |
40 |
39 |
$338.40 |
| 90670 |
|
238 |
237 |
$309.59 |
| 90715 |
|
25 |
25 |
$306.40 |
| 96127 |
|
55 |
45 |
$238.48 |
| 80053 |
Comprehensive metabolic panel |
25 |
24 |
$232.32 |
| 92552 |
|
33 |
33 |
$173.64 |
| 92015 |
Determination of refractive state |
18 |
18 |
$79.76 |
| 90688 |
|
29 |
29 |
$79.64 |
| 90697 |
|
13 |
12 |
$62.10 |
| 99490 |
Ccm add 20min |
12 |
12 |
$48.80 |
| 99173 |
|
32 |
32 |
$35.12 |
| 90633 |
|
70 |
70 |
$29.55 |
| 36415 |
Collection of venous blood by venipuncture |
30 |
25 |
$18.86 |
| 90707 |
|
88 |
88 |
$0.00 |
| 90713 |
|
154 |
154 |
$0.00 |
| 90700 |
|
254 |
253 |
$0.00 |
| 90687 |
|
19 |
19 |
$0.00 |
| 90648 |
|
136 |
136 |
$0.00 |
| 91300 |
|
12 |
12 |
$0.00 |
| 90716 |
|
74 |
74 |
$0.00 |
| 90680 |
|
12 |
12 |
$0.00 |
| 90686 |
|
29 |
29 |
$0.00 |
| 90651 |
|
29 |
28 |
$0.00 |